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Infertility Cubby

So, You're Going to See the Reproductive Endocrinologist?
by Chelsey Langland

Congratulations! You have made the decision to take a proactive, tangible step towards addressing your inability to conceive. Maybe you have been trying to conceive for 12 months now. Or, maybe you have gone through some preliminary testing, and your gynecologist has recommended that you progress to a specialist. Whatever the reason, a reproductive endocrinologist (RE, for short) is the best person to help you achieve your goal of becoming a mother.

An RE is an ob/gyn who has completed several years of training beyond the general ob/gyn residency. All REs must be board certified by the American College of Obstetricians and Gynecology (ACOG). The important thing to remember is that an RE is focused on helping women become pregnant. REs do not deliver babies or perform annual exams. Instead, their sole focus is on helping you overcome your particular infertility issue. That is a very comforting thought. So, how should you find an RE to guide your treatment? If you are lucky enough to have insurance coverage for infertility matters, consult your insurance company for a list of providers who contract with your plan. If you will be paying for the treatment out of pocket, do some investigation. You can find a list of REs on-line at www.asrm.org, which is the Web site of the American Society for Reproductive Medicine. Resolve, the national infertility organization, can also help with the RE selection process. You may visit them at www.resolve.org.

What should you expect at your first visit? That can vary from office to office. For the most part, at the first visit the RE will just want to get to know you. He or she will ask about your medical history, any diagnostic procedures you have had so far, and your procreative efforts to date. The doctor may lay out the tests which are necessary to be performed. There may also be some discussion about treatment options. You should also have the opportunity to speak with the billing office, and should be informed about the doctor's financial policies. It may be that your first visit does not involve a physical exam. The initial tests must be done on certain days of your cycle, which means that you will have to wait until day one of your next cycle to get started.

You will likely be told to contact the office on the first day of your new cycle. There is very important blood work that must be done on day three of your cycle. These tests include checks of your:

  • follicle stimulating hormone (FSH);
  • lutenizing hormone (LH); and
  • thyroid stimulating hormone.

These tests are checking your ovarian reserve (the "age" of your eggs), as well as making sure that you have an adequate ratio of LH to FSH. The doctor may also be concerned with your thyroid function, since hyper- or hypo-thyroid can negatively impact your fertility.

The RE will also want to check and see whether your fallopian tubes are open. To do this, s/he will likely want you to undergo a hysterosalpingogram, or HSG. During the HSG, a radiologist or your RE will dilate your cervix and force some radioactive dye up through your uterus and into your fallopian tubes. An x-ray machine tracks everything in real time, so you will be able to see whether the dye freely flows up through your tubes and spills out of your ovaries. This procedure can be uncomfortable, but the discomfort only lasts for a few minutes, and you can take some Advil or Tylenol before the procedure begins. Best of all, you get immediate results, and it is interesting to see your plumbing on a video screen.

It is also very important that the RE make arrangements for your partner to undergo a semen analysis (SA). While this might not be your partner's favorite thing to do, it is essential to determine whether your trouble getting pregnant is attributable to a male factor problem. The RE's office deals with dozens of SAs every day, and the office will make things as comfortable as possible for your partner. Many clinics have special rooms, complete with white noise machines and magazines. In some cases, you can produce the sample at home and deliver it to the lab. You can discuss the specifics with your RE and your partner.

So, the blood tests have shown that everything is in order with your hormone levels, your tubes and uterus look normal, and your partner's SA shows that everything is within normal limits. Yet, you are still not getting pregnant. What is next? Your RE may suggest that you under to a laparoscopy (a lap). In this procedure, the RE investigates your abdomen through a camera. The surgery requires a few small incisions, and is usually done on an out-patient basis. The lap allows the doctor to determine whether you have endometriosis, or whether you have adhesions that are preventing the egg from getting to the uterus.

Seeing an RE can be both an exciting and a scary time. It can be difficult to admit that you might have a problem that requires specialized medical care. However, an RE has one goal, and that is to help you get pregnant. Hopefully, if you know what to expect at your appointments the process will be less scary.

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